Monday, December 8, 2014

Wales to debate assisted suicide, Kevin Fitzpatrick responds.

Written by Dr Kevin Fitzpatrick, OBE, to two members of the Welch assembly.

Dr Fitzpatrick is the Director of EPC - International and the spokesperson for the disability rights group, Not Dead Yet - UK.

Kevin Fitzpatrick speaking atthe European Parliament

I understand that in just two days time, the Welsh Assembly will debate whether there is support for wider legislation permitting assisted suicide/euthanasia (AS/E). I am writing to you most urgently to ask you to consider how such legislation affects all citizens, but especially disabled people.

There are deep and serious questions when someone says ‘I wish to die’. For example, amongst many factors, the thought can seduce someone in a vulnerable moment. Disabled people know this seduction as well as any.

So our difficulty here is not focused on individual vulnerability - but on the consequences of introducing a law, ‘permitting’ the intervention of any third party into end-of-life decisions. Such laws have the most awful, fatal outcomes for disabled and other vulnerable people. Overwhelming evidence from other jurisdictions, including and particularly Oregon in the context of the proposed legislation, makes that clear

Disabled people are most at risk from this legislation - largely due to discrimination solely on the grounds of disability

Anyone faced with such an end-of-life decision can be ‘vulnerable’. AS/E laws, implemented by practitioners or not, have terminal consequences for vulnerable disabled people.

The AS/E lobby most often cite incontinence as such ‘a loss of dignity’ that makes the wish to commit suicide simply self-evident. As many disabled people like myself will tell you, managing incontinence can be challenging, but it is not a reason to decide to commit suicide in whichever manner. And if anyone does feel suicidal, for this or any other reason, what should our response be? There is an attitudinal reaction embedded here from non-disabled people, who 'fear becoming' like us, disabled - it is based in the same ignorance and prejudice as other moments of discrimination against disabled people - only this time its has fatal consequences.

The lobby for AS/E laws speaks often about choice and autonomy – legislation works in exactly the opposite manner – it removes all choice from the patient and puts it squarely into the hands of, in this case doctors.

In all jurisdictions with AS/E laws it is given to doctors to decide which of us is, or can be, a candidate for an assisted suicide. This radically alters the patient-practitioner relationship, trust is fatally broken, patient safety is no longer the core of good clinical governance - moreover, all public safety is threatened.

Medical practitioners cannot be assumed to be (always) the best judges of what is a moral decision to end a human life – administering a lethal injection is never an act of medicine – it is when medicine says ‘we have nothing left to try’.

Doctors are open to every frailty in human life, and making such decisions, with the added difficulty of sometimes becoming inured to death, by experiencing it often and mostly in a clinical, sterile setting, they are not always, perhaps not even often, the best judges. Those doctors who recognise this, the majority, are against this legislation. The law, as it stands, also provides those doctors with some protection from being forced to legally comply and take the life of another human being. They do not want to be forced into actions which are not medicine, and directly contravene their Hippocratic Oath. Further:

Killing the sufferer is not the only, and certainly not ever the only correct response to anyone’s suffering.

Legislation which permits, blanket-fashion, the intervention of a third party to take over end-of-life decision-making for an individual is more than dangerous, partly because of its immediate extension especially to non-terminally ill disabled people. In the terms of this current draft Bill, people with ‘a progressive illness’ will be eligible; it will envelope so many disabled people. As other jurisdictions have, we will find that considering the request to die of a depressed disabled person will be treated as self-evident, ‘reasonable’ by non-disabled decision-makers.

Why should disabled people have a ‘legitimising’, white-sleeved medical arm round their shoulder and an apparently ‘authoritative’ response to their feelings of desperation? Non-disabled people who despair of their future are treated with support, care, and our first, proper aspiration is to help them past their despair; disabled people are told ‘well, of course we understand, you’ve done enough already, suffered in ways we can’t imagine and do not want for ourselves – we will help you to die.’ This is rank discrimination solely on the basis of disability.

...I have merely pointed at the tip of the proverbial iceberg in this short note. There are so many deeper concerns below the surface. I hope you will feel the weight of those questions is sufficient to make anyone stop and say ‘Hang on a moment – this is not as clear as it seemed at first glance’.

If so, then we can have time to explore the evidence which has emerged.

When I began to investigate this issue 3-4 years ago, I had no idea how dangerous this ‘movement’ could be; but I am clear now. It can seem perfectly reasonable at first glance, yet serious consideration almost immediately reveals the dangers, and the damage that such laws bring to whole societies, let alone to so many individuals.